title: Perspectives of men on antenatal and delivery care service utilisation in rural western Kenya: a qualitative study.
abstract: BACKGROUND
  Poor utilisation of facility-based antenatal and delivery care services in Kenya hampers reduction of maternal mortality. Studies suggest that the participation of men in antenatal and delivery care is associated with better health care seeking behaviour, yet many reproductive health programs do not facilitate their involvement. This qualitative study conducted in rural Western Kenya, explored men's perceptions of antenatal and delivery care services and identified factors that facilitated or constrained their involvement.
  
  
  METHODS
  Eight focus group discussions were conducted with 68 married men between 20-65 years of age in May 2011. Participants were of the Luo ethnic group residing in Asembo, western Kenya. The area has a high HIV-prevalence and polygamy is common. A topic guide was used to guide the discussions and a thematic framework approach for data analysis.
  
  
  RESULTS
  Overall, men were positive in their views of antenatal and delivery care, as decision makers they often encouraged, some even 'forced', their wives to attend for antenatal or delivery care. Many reasons why it was beneficial to accompany their wives were provided, yet few did this in practice unless there was a clinical complication. The three main barriers relating to cultural norms identified were: 1) pregnancy support was considered a female role; and the male role that of provider; 2) negative health care worker attitudes towards men's participation, and 3) couple unfriendly antenatal and delivery unit infrastructure.
  
  
  CONCLUSIONS
  Although men reported to facilitate their wives' utilisation of antenatal and delivery care services, this does not translate to practice as adherence to antenatal-care schedules and facility based delivery is generally poor. Equally, reasons proffered why they should accompany their wives are not carried through into practice, with barriers outweighing facilitators. Recommendations to improve men involvement and potentially increase services utilisation include awareness campaigns targeting men, exploring promotion of joint HIV testing and counselling, staff training, and design of couple friendly antenatal and delivery units.
authors.affiliation: KEMRI/CDC Research and Public Health Collaboration, Kisumu, Kenya. tituskwambai@yahoo.com
authors.forename: Titus K
authors.initials: TK
authors.lastname: Kwambai
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dellicour
authors.forename: Meghna
authors.initials: M
authors.lastname: Desai
authors.forename: Charles A
authors.initials: CA
authors.lastname: Ameh
authors.forename: Bobbie
authors.initials: B
authors.lastname: Person
authors.forename: Florence
authors.initials: F
authors.lastname: Achieng
authors.forename: Linda
authors.initials: L
authors.lastname: Mason
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.forename: Feiko O
authors.initials: FO
authors.lastname: Ter Kuile
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D005783:Gender Identity; D017048:Health Care Costs; D006272:Health Facility Environment; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006761:Hospitals; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D008880:Midwifery / Q000191:economics; D010332:Paternal Behavior; D010349:Patient Compliance / Q000208:ethnology; D010465:Perception; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D055815:Young Adult